BackgroundA large number of maternal and neonatal deaths occur during birth and 48 h after birth. The benefits of postnatal care to the mother and newborn cannot be overemphasized as this is another opportunity where complications that might arise from pregnancy and childbirth can be treated, as well as the time to provide important information on maternal and newborn care after delivery. This study aimed to determine the information needs of mother-baby pairs in the first 6 weeks after birth.MethodsAn exploratory qualitative study using in-depth interviews at three points in time was conducted with 15 women who had their births at Moi Teaching and Referral Hospital, Kenya. The first interview was done within 48 h after birth followed by a telephone interview at 2 weeks and at 6 weeks after birth. Data were audio recorded and transcribed. Transcripts and field notes were analyzed using thematic content analysis and NVIVO 11 software. Ethical approval was obtained before commencement of studies and permission to conduct the study granted by the chief executive of the hospital.ResultsThe only health needs that participants reported were unmet health information needs. Four major themes emerged from the study. ‘Connecting with baby’ centered on understanding and meeting baby’s needs, monitoring growth and progress and protecting the baby. The second theme: “Birth as a unique encounter’ is a blend of what was found to be new and a unique. The theme ‘Regaining self’ is a combination of managing self as a mother and handling discomfort related to birth. The final theme: ‘Disconnected information’ is a collection of unmet information needs, the need for clarity in information booklets and conflicting information by different providers.ConclusionsParticipants used the hospital stay as an opportunity to receive more detailed information on how to take care of their babies both directly after birth and in the longer term. Participants had a range of unmet health information needs that extended beyond family planning and fertility. Needs extended to their own care and management of discomforts. The need for consistency in health information by different providers and updated printed material on postnatal care that includes sensitive information and allows opportunities for personalized information was highlighted.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1576-1) contains supplementary material, which is available to authorized users.
Background This is the fifth study that applied the International Study of Asthma and Allergies in Childhood (ISAAC) methodology in the Southern African Development Community (SADC region). However, it is the first ISAAC study that focused on 6-to 7-year-old children living in South Africa and that also investigated the association between potential risk factors and asthma symptoms. Objective To assess the 12-month prevalence of wheeze and severe wheeze along with their potential risk factors. Setting Within a 60-km radius from the Polokwane city centre, Limpopo Province. Methods The survey was conducted during August 2004 and February 2005. Parents/guardians of 6-to 7-year-old children completed the questionnaires in English, Afrikaans or North-Sotho. However, the statistical analyses were restricted to the North-Sotho group (n = 2,437). Results The 12-month prevalence rates of wheeze and severe wheeze were 11.2% and 5.7%, respectively. The 12-month prevalence rates of eczema symptoms and rhinoconjunctivitis symptoms were 8.0% and 7.3%, respectively. Living in a rural area significantly decreased the likelihood of wheeze by 31%. Exposure to environmental tobacco smoke at home and the presence of eczema symptoms and rhinoconjunctivitis symptoms increased the likelihood of wheeze by 77%, 104% and 226%, respectively. Only the presence of rhinoconjunctivitis symptoms increased the likelihood of severe wheeze by 107%. Conclusion Wheeze appears to be an emerging public health problem in the Polokwane area. Hopefully, detailed analytical intervention studies will further explicate these results in the near future.
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BackgroundIn South Africa, much of diabetes care takes place at primary healthcare (PHC) facilities where screening for diabetic complications is often low. Clinics require access to equipment, resources and a functional health system to do effective screening, but what is unknown is whether these components are in place.AimThe aim of this study was to assess the capacity of primary care clinics in one district to provide quality diabetes care.SettingThis study was conducted at the Tshwane district in South Africa.MethodsAn audit was done in 12 PHC clinics. A self-developed audit tool based on national and clinical guidelines was developed and completed using observation and interviewing the clinic manager and pharmacist or pharmacy assistant.ResultsScales, height rods, glucometers and blood pressure machines were available. Monofilaments were unknown and calibration of equipment was rare. The Essential Drug List was the only guideline consistently available. All sites reported consistent access to medication, glucose strips and urine dipsticks. All sites made use of the chronic disease register, and only 25% used an appointment system. No diabetes-specific structured care form was in use. All facilities had registered and enrolled nurses and access to doctors. Availability of educational material was generally poor.ConclusionThe capacity to deliver quality care is compromised by the poor availability of guidelines, educational material and the absence of monofilaments. These are modifiable risk factors that could be resolved by the clinic managers and staff development educators. However, patient records and health information systems need attention at policy level.
BackgroundThe South African Department of Health implemented the nurse-initiated management of antiretroviral treatment (NIM-ART) programme as a policy to decentralise services. Increasing access to ART through nurse initiation results in significant consequences.AimThis study evaluated the quality of care provided, the barriers to the effective rollout of antiretroviral services and the role of a clinical mentor.SettingThe study was conducted at three NIM-ART facilities in South Africa. One clinic provided a high standard of care, one had a high defaulter rate, and at the third clinic, treatment failures were missed, and routine bloods were not collected.MethodsA mixed methods study design was used. Data were collected using patient satisfaction surveys, review of clinical records, facility audits, focus group interviews, field notes and a reflection diary.ResultsNIM-ART nurses prescribed rationally and followed antiretroviral guidelines. Mortality rates and loss to follow-up rates were lower than those at the surrounding hospitals, and 91.1% of nurse-monitored patients had an undetectable viral load after a year. The quality of care provided was comparable to doctor-monitored care. The facility audits found recurrent shortages of essential drugs. Patients indicated a high level of satisfaction. Salary challenges, excessive workload, a lack of trained nurses and infrastructural barriers were identified as barriers. On-going mentoring and support by a clinical mentor strengthened each of the facilities, facilitated quality improvement and stimulated health workers to address constraints.ConclusionClinical mentors are the key to addressing institutional treatment barriers and ensuring quality of patient care.
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